Secular Trends of Clinical Characteristics and Survival of Hepatocellular Carcinoma in Taiwan from 2011 to 2019

Abstract

Hepatocellular carcinoma (HCC) is a major cause of cancer death in Taiwan, and in the past 30-40 years, Taiwan has been committed to its prevention and treatment. We aimed to investigate the secular trends of characteristics and the survival of HCC in recent decades after making increased efforts. Between 2011 and 2019, a total of 73,817 cases were enrolled from the TCR database. The overall male-to-female ratio was 7/3. The overall, male and female mean ages increased from 63.8 to 66.1 years, 62.0 to 64.3 years and 68.3 to 70.4 years, respectively. After dividing by viral etiologies and gender, the mean age showed increasing trends in all subgroups. The proportions of HBV-HCC, HCV-HCC, HBV+HCV-HCC and Non-HBV+non-HCV-HCC were 48.3%, 25.2%, 5.3% and 21.3% in males, compared with 25.5%, 48.6%, 5.3% and 20.5% in females, respectively. The 5-year survival rates of BCLC stages 0, A, B, C and D were 70%, 58%, 34%, 11% and 4%, respectively. The proportion of BCLC stage 0 increased from 6.2% to 11.3%. Multivariate analysis showed that being female, older age, diagnostic year, BCLC stages, hospital level, body mass index, smoking, alcohol consumption, AFP, Child-Pugh classification and HBV/HCV status were independent predictors for survival. In recent decades, the overall survival of HCC in Taiwan has been improving and might be partly associated with increased BCLC 0 and Child-Pugh A patients, while with the consequent age of patients increasing over time. The proportion of viral-related HCC is decreasing, while nonviral-related HCC is increasing.

Keywords: age; gender; hepatitis B virus; hepatitis C virus; hepatocellular carcinoma; non-B and non-C viral hepatitis; survival.

Figure 1

Secular trends of mean age from 2011 to 2019. The overall, male and female mean ages at diagnosis increasing annually over time (all p values for linear trend <0.01). Mean age of females were about 6 years older than males on average when diagnosis.

Figure 2

Child–Pugh classification from 2011 to 2019 shows liver function reserve improved over time (all p values for linear trend <0.01). Proportion of Child–Pugh class A increased from 72.5% to 80.7%. The proportions of Child–Pugh B and C decreased from 19.9% to 15.3% and from 7.6% to 4.0%, respectively.

Figure 3

Secular trends of viral etiologies according to gender. (a) In male gender, HBV accounts for half of the cases. The proportion of NBNC-HCC increased over time, while the proportion of C-HCC decreased (all p values for linear trend <0.001). (b) In female gender, HCV accounts for nearly half of HCC cases. The proportions of B-HCC and NBNC-HCC increased, while the proportion of C-HCC decreased over time (all p values for linear trend <0.001).

Figure 4

All mean ages during the time period classified according to gender and viral etiology showed increasing trends in both male (a) and female (b) gender (all p values for linear trend <0.01).

Figure 5

The male-to-female ratios of overall, B-HCC, C-HCC, B+C-HCC and NBNC-HCC were 2.4, 4.6, 1.3, 2.4 and 2.5, respectively. The B-HCC showed decreasing trend from 4.8 to 4.1 during the study period.

Figure 6

The distribution of BCLC stages from 2011 to 2019. The proportion of BCLC stage 0 increased from 6.2% to 11.3% (p value for linear trend <0.01), while the proportion of both BCLC stages A and B decreased (p values for linear trend <0.01). The sum of BCLC stages 0, A and B did not change significantly.

Figure 7

The overall median survival rates of HCC from 2011 to 2019 improved year-by-year.